for Journals by Title or ISSN
for Articles by Keywords

Publisher: Elsevier   (Total: 3030 journals)

 A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Showing 1 - 200 of 3030 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 79, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 22, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 303, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 196, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 21, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 120, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 24, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 38, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 41, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 18, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 33, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 7, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 6, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 20, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 14)
Advances in Pharmacology     Full-text available via subscription   (Followers: 13, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 17, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 56)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 1, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 332, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 7)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 28, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 14)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 12)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 42, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 304, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 390, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 29, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 36, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 48, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 3, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 7, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 45, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 45, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 48, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 174, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 51, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 22, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 32, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 13, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 3)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 154, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 7, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 143, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Journal Cover American Journal of Ophthalmology
  [SJR: 2.803]   [H-I: 148]   [51 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9394
   Published by Elsevier Homepage  [3030 journals]
  • Strabismus Measurements in Adults Before and After Pupil Dilation
    • Authors: Sean S. Rivera; Michael S. Lee; Scott Lunos; Jill S. Anderson; Erick D. Bothun
      Pages: 1 - 8
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Sean S. Rivera, Michael S. Lee, Scott Lunos, Jill S. Anderson, Erick D. Bothun
      Purpose To determine the effect of dilating drops on strabismus measurements in adults. Design Prospective cohort study. Methods Patients aged 18 and older with strabismus underwent a standard evaluation of ocular motility, stereopsis, and ocular alignment with alternate prism cover test by a certified orthoptist. After pupil dilation with 2.5% phenylephrine and 1% tropicamide, ocular alignment was remeasured in primary gaze at 6 meters, at 1/3 meter, and at 1/3 meter with a +3.00 by a second certified orthoptist, masked to the previous measurements. The primary outcome was the mean difference in the angle of horizontal and vertical deviations after dilation in prism diopters. Results A total of 55 patients were enrolled with a variety of diagnoses. For horizontal measurements the mean change was 0.54 prism diopters at 6 meters (95% confidence interval [CI] −0.36 to 1.43, P = .24), 1.67 prism diopters at 1/3 meter (95% CI −0.19 to 3.54, P = .08), and −0.05 prism diopters at 1/3 meter with a +3.00 add (95% CI −1.65 to 1.56, P = .95). The mean change in vertical deviation was 0.18 prism diopters at 6 meters (95% CI −0.19 to 0.56, P = .34), 0.57 prism diopters at 1/3 meter (95% CI 0–1.15, P = .05), and 0.47 prism diopters at 1/3 meter with a +3.00 add (95% CI −0.23 to 1.17, P = .18). Conclusions Pupil dilation does not meaningfully affect vertical or horizontal strabismus measurements in adults. Mild variability at near in younger patients is eliminated with the use of a +3.00 add.

      PubDate: 2017-04-04T08:37:22Z
      DOI: 10.1016/j.ajo.2017.03.004
      Issue No: Vol. 178 (2017)
  • Glaucoma Patient–Reported Concerns and Associated Factors
    • Authors: Rachel S. Mogil; Andrew Tirsi; Jung Min Lee; Celso Tello; Sung Chul Park
      Pages: 9 - 17
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Rachel S. Mogil, Andrew Tirsi, Jung Min Lee, Celso Tello, Sung Chul Park
      Purpose To assess the character and degree of concerns of glaucoma patients and identify demographic/clinical factors affecting the concerns. Design Prospective cross-sectional study. Methods A questionnaire that addressed patients' concerns was administered to consecutive glaucoma patients. Severity of concern was scored with a scale of 0–5 in order of increasing severity. Age, sex, intraocular pressure, visual field (VF) mean deviation (MD), number of antiglaucoma medications, history of glaucoma surgery, and employment status were recorded. Results Questionnaire results of 152 patients (mean VF MD, −8.03 ± 7.86 dB [better eye] and −16.06 ± 10.22 dB [worse eye]; mean age, 69 ± 14 years) were analyzed. Severity of concern was greatest for general eyesight (2.92/5.00) and visual symptoms (2.78/5.00), followed by activities (2.20/5.00) and socioeconomic factors (2.13/5.00), and then ocular symptoms (1.69/5.00) (P < .001). The most common concerns within each domain were blurry vision (32%), reading small print (34%), medical costs (26%), and dryness (32%). Concern about visual symptoms correlated with VF MD of the better eye (r = −0.258; P = .001) and worse eye (r = −0.233; P = .004). Concern about activities correlated with history of glaucoma surgery (r = 0.148; P = .023) and VF MD of the better eye (r = −0.284; P < .001) and worse eye (r = −0.295; P < .001). Concern about socioeconomic factors correlated with VF MD of the better eye (r = −0.245; P = .003) and age (r = −0.260; P = .001). Conclusions Glaucoma patients reported varied degrees of concern regarding items associated with quality of life. Certain items may be more concerning than others. Severity of some concerns increased with more severe VF loss, prior glaucoma surgery, or younger age.

      PubDate: 2017-04-04T08:37:22Z
      DOI: 10.1016/j.ajo.2017.03.009
      Issue No: Vol. 178 (2017)
  • Quantitative Analysis of Retinal Structure Using Spectral-Domain Optical
           Coherence Tomography in RPGR-Associated Retinopathy
    • Authors: James J.L. Tee; Joseph Carroll; Andrew R. Webster; Michel Michaelides
      Pages: 18 - 26
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): James J.L. Tee, Joseph Carroll, Andrew R. Webster, Michel Michaelides
      Purpose To quantify retinal structure and progression using spectral-domain optical coherence tomography (SDOCT) in patients with retinitis pigmentosa (RP) associated with retinitis pigmentosa GTPase regulator gene (RPGR) mutations. Design Retrospective observational case series. Methods Setting : Moorfields Eye Hospital, London, United Kingdom. Subjects : Both eyes of 32 patients. SDOCT follow-up period of >1 year (3.1 ± 1.4 years). Main Outcome Measures : Ellipsoid zone (EZ) width (EZW) and outer nuclear layer (ONL) and inner retinal layer (IRL) thickness measurements. Progression rates, interocular symmetry, and association with age and genotype were investigated. Results Significant differences were observed between baseline and final measurements of EZW and ONL thickness, but not for IRL thickness. Baseline and final EZWs were 2438 ± 1646 μm and 1901 ± 1423 μm for right eyes (P < .0001); 2420 ± 1758 μm and 1922 ± 1482 μm for left eyes (P < .0001). EZW constriction rates were 176.6 ± 130.1 μm/year and 173.1 ± 146.8 μm/year for right and left eyes. ONL thinning rates were 2.58 ± 2.85 μm/year and 2.52 ± 3.54 μm/year for right and left eyes. Interocular differences in EZW and ONL progression were not significant (P = .8609 and P = .6735, respectively). Strong correlations were found between EZW constriction rates of right and left eyes (rs = 0.627, P = .0002) and between EZW constriction and baseline EZW (rs = 0.714, P < .0001). There was moderate negative correlation between EZW constriction and age (rs = −0.532, P < .0001). Correlation between ONL thinning and age was not significant, as were differences between EZW and ONL progression rates with respect to genotype. Conclusions This study provides SDOCT progression rates for RPGR-associated RP. There is overall interocular symmetry with implications for future treatment trials where 1 eye could serve as a control.

      PubDate: 2017-04-04T08:37:22Z
      DOI: 10.1016/j.ajo.2017.03.012
      Issue No: Vol. 178 (2017)
  • In Vivo Characteristics of Corneal Endothelium/Descemet Membrane Complex
           for the Diagnosis of Corneal Graft Rejection
    • Authors: Mohamed Abou Shousha; Sonia H. Yoo; Mohamed S. Sayed; Sean Edelstein; Matthew Council; Ravi S. Shah; Joshua Abernathy; Zachary Schmitz; Patrick Stuart; Rocio Bentivegna; Maria P. Fernandez; Christopher Smith; Xiaotang Yin; George J. Harocopos; Sander R. Dubovy; William J. Feuer; Jianhua Wang; Victor L. Perez
      Pages: 27 - 37
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Mohamed Abou Shousha, Sonia H. Yoo, Mohamed S. Sayed, Sean Edelstein, Matthew Council, Ravi S. Shah, Joshua Abernathy, Zachary Schmitz, Patrick Stuart, Rocio Bentivegna, Maria P. Fernandez, Christopher Smith, Xiaotang Yin, George J. Harocopos, Sander R. Dubovy, William J. Feuer, Jianhua Wang, Victor L. Perez
      Purpose To evaluate the utility of endothelial/Descemet membrane complex (En/DM) characteristics in diagnosing corneal graft rejection. Design Diagnostic reliability study. Methods One hundred thirty-nine eyes (96 corneal grafts post penetrating keratoplasty or Descemet stripping automated endothelial keratoplasty: 40 clear, 23 actively rejecting, 24 rejected, and 9 nonimmunologic failed grafts; along with 43 age-matched control eyes) were imaged using high-definition optical coherence tomography. Images were used to describe En/DM and measure central corneal thickness (CCT) and central En/DM thickness (DMT). En/DM rejection index (DRI) was computed to detect the relative En/DM thickening to the entire cornea. Results In actively rejecting grafts, DMT and DRI were significantly greater than controls and clear grafts (28, 17, and 17 μm and 1.5, 1 and 1, respectively; P < .001). Rejected grafts had the highest DMT and DRI compared to all groups (59 μm and 2.1; P < .001). DMT and DRI showed excellent accuracy, significantly better than that of CCT, in differentiating actively rejecting from clear grafts (100% and 96% sensitivity; 92.5% and 92.5% specificity), actively rejecting from rejected grafts (88% and 83% sensitivity; 91% and 83% specificity), and nonimmunologic failed from rejected grafts (100% and 100% sensitivity; 88% and 100% specificity). DMT correlated significantly with rejection severity (P < .001). Conclusions In corneal grafts, in vivo relative thickening of the En/DM is diagnostic of graft rejection as measured by DMT and DRI. These indices have excellent accuracy, sensitivity, and specificity in detecting graft immunologic status, superior to CCT. DMT is a quantitative index that correlates accurately with the severity of rejection.

      PubDate: 2017-04-11T08:48:30Z
      DOI: 10.1016/j.ajo.2017.02.026
      Issue No: Vol. 178 (2017)
  • Comparing the Rates of Retinal Nerve Fiber Layer and Ganglion Cell–Inner
           Plexiform Layer Loss in Healthy Eyes and in Glaucoma Eyes
    • Authors: Naama Hammel; Akram Belghith; Robert N. Weinreb; Felipe A. Medeiros; Nadia Mendoza; Linda M. Zangwill
      Pages: 38 - 50
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Naama Hammel, Akram Belghith, Robert N. Weinreb, Felipe A. Medeiros, Nadia Mendoza, Linda M. Zangwill
      Purpose To compare the rates of circumpapillary retinal nerve fiber layer (RNFL) and macular retinal ganglion cell–inner plexiform layer (GCIPL) change over time in healthy and glaucoma eyes. Design Cohort study. Methods The rates of circumpapillary RNFL and macular GCIPL loss in 28 healthy subjects and 97 glaucoma subjects from the Diagnostic Innovations in Glaucoma Study (DIGS) were compared using mixed-effects models. Results The median follow-up time and number of visits were 1.7 years and 6 visits and 3.2 years and 7 visits for healthy and glaucoma eyes, respectively. Significant rates of loss of both global circumpapillary RNFL and average macular GCIPL thickness were detectable in early and moderate glaucoma eyes; in severe glaucoma eyes, rates of average macular GCIPL loss were significant, but rates of global circumpapillary RNFL loss were not. In glaucoma eyes, mean rates of global circumpapillary RNFL thickness change (−0.98 μm/year [95% confidence interval (CI), −1.20 to −0.76]) and normalized global circumpapillary RNFL change (−1.7%/year [95% CI, −2.1 to −1.3]) were significantly faster than average macular GCIPL change (−0.57 μm/year [(95% CI, −0.73 to −0.41]) and normalized macular GCIPL change (−1.3%/year [95% CI, −1.7 to −0.9]). The rates of global and inferior RNFL change were weakly correlated with global and inferior macular GCIPL change (r ranges from 0.16 to 0.23, all P < .05). Conclusions In this cohort, the rate of circumpapillary RNFL thickness change was faster than macular GCIPL change for glaucoma eyes. Global circumpapillary RNFL thickness loss was detectable in early and moderate glaucoma, and average macular GCIPL thickness loss was detectable in early, moderate, and severe glaucoma, suggesting that structural changes can be detected in severe glaucoma.

      PubDate: 2017-04-11T08:48:30Z
      DOI: 10.1016/j.ajo.2017.03.008
      Issue No: Vol. 178 (2017)
  • Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation
           and Cross-linking in Pediatric Keratoconus
    • Authors: Youssef Abdelmassih; Sylvain el-Khoury; Ali Dirani; Rafic Antonios; Ali Fadlallah; Carole G. Cherfan; Elias Chelala; Elias F. Jarade
      Pages: 51 - 57
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Youssef Abdelmassih, Sylvain el-Khoury, Ali Dirani, Rafic Antonios, Ali Fadlallah, Carole G. Cherfan, Elias Chelala, Elias F. Jarade
      Purpose To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by cross-linking in pediatric keratoconus patients. Design Retrospective interventional case series. Methods This retrospective study included pediatric patients (aged ≤14 years) with keratoconus and poor corrected distance visual acuity (CDVA) that underwent ICRS implantation and cross-linking (CXL). ICRS were inserted under topical anesthesia after creating a corneal tunnel with a femtosecond laser. Cross-linking was performed 1 month subsequently. Records were reviewed and data collected preoperatively and at 6 months, 1 year, 2 years, and 4 years postoperatively. Results Twelve patients (17 eyes; 10 male, 2 female) aged 9–14 years (mean age 12.3 years) received ICRS implantation followed by CXL. Follow-up times ranged from 6 months to 4 years after surgery. At the 6-month follow-up all eyes were evaluated; at the 1-year, 2-year, and 4-year follow-up 11, 10, and 7 eyes were evaluated, respectively. At the 6-month follow-up, mean CDVA in comparison to preoperative levels improved significantly (P = .001) from 0.30 ± 0.19 logMAR to 0.12 ± 0.1 logMAR; mean uncorrected distance visual acuity (UDVA) also improved significantly from 0.90 ± 0.50 logMAR to 0.43 ± 0.31 logMAR. A significant decrease in both keratometry readings and spherical equivalent (from −4.0 to −1.56 diopters) was also noted after ICRS insertion. At the 1-year, 2-year, and 4-year follow-up refractive values remained relatively stable in comparison to the 6-month follow-up, except for a minor but significant improvement in cylinder and, at 4 years, in UDVA. All patients tolerated the surgery well and no intraoperative or postoperative complications were reported, except for 1 ring segment that had to be removed after 2 years owing to vascularization and corneal thinning. Conclusion ICRS implantation is a safe and effective procedure for visual rehabilitation in children with keratoconus and poor CDVA.

      PubDate: 2017-04-11T08:48:30Z
      DOI: 10.1016/j.ajo.2017.03.016
      Issue No: Vol. 178 (2017)
  • Comparison of Axial Length, Corneal Curvature, and Anterior Chamber Depth
           Measurements of 2 Recently Introduced Devices to a Known Biometer
    • Authors: Mehdi Shajari; Carla Cremonese; Kerstin Petermann; Pankaj Singh; Michael Müller; Thomas Kohnen
      Pages: 58 - 64
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Mehdi Shajari, Carla Cremonese, Kerstin Petermann, Pankaj Singh, Michael Müller, Thomas Kohnen
      Purpose Evaluate agreement and repeatability of axial length (AL), corneal curvature, and anterior chamber depth measurements of 2 new devices, 1 using Scheimpflug technology combined with partial coherence interferometry (Pentacam AXL) and 1 using swept-source optical coherence tomography (IOL Master 700) to a widely used optical biometer (IOL Master 500). Design Prospective, instrument reliability analysis. Methods This study was conducted in the Department of Ophthalmology at Goethe-University, Frankfurt, Germany. Seventy-nine eyes in 79 patients were measured with the IOL Master 500, the IOL Master 700, and with the Pentacam AXL. All eyes were measured twice with each device. The results were statistically compared using Bland–Altman plots. Outcome measures included AL, corneal curvature, and the measurement of anterior chamber depth. Results The Bland–Altman analysis of axial length measurements with the IOL Master 500 and IOL Master 700 showed a mean difference of 0.008 mm between the 2 devices, with a coefficient of repeatability (COR) of 0.044 (P = .05). For measurements with the IOL Master 500 and Pentacam AXL, a mean difference of 0.026 mm and COR of 0.055 (P = .75) was found. For measurements with Pentacam AXL and IOL Master 700, a mean difference of −0.019 mm and COR of 0.052 (P = .06) was found. In terms of repeatability, there was no significant difference in measurement of any variable with any device. Vector analysis showed no significant difference for corneal astigmatism measurements (P = .84). Conclusion There was no statistically significant difference in compared biometric parameters performed with all 3 devices.

      PubDate: 2017-04-11T08:48:30Z
      DOI: 10.1016/j.ajo.2017.02.027
      Issue No: Vol. 178 (2017)
  • Performance of the Spot Vision Screener in Children Younger Than 3 Years
           of Age
    • Authors: Blake D. Forcina; M. Millicent Peterseim; M. Edward Wilson; Edward W. Cheeseman; Samuel Feldman; Amanda L. Marzolf; Bethany J. Wolf; Rupal H. Trivedi
      Pages: 79 - 83
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Blake D. Forcina, M. Millicent Peterseim, M. Edward Wilson, Edward W. Cheeseman, Samuel Feldman, Amanda L. Marzolf, Bethany J. Wolf, Rupal H. Trivedi
      Purpose To evaluate the use of the Spot Vision Screener (Spot; Welch Allyn, Skaneateles Falls, New York, USA) for detection of amblyopia risk factors in children aged 6 months to 3 years, as defined by the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus. Design Reliability analysis. Methods In this study, children seen from June 1, 2012, to April 30, 2016 were tested with the Spot during a routine visit. Enrolled children underwent a comprehensive eye examination including cycloplegic refraction and sensorimotor testing within 6 months of the testing date by a pediatric ophthalmologist masked to the Spot results. Results A total of 184 children were included. The Spot successfully obtained readings in 89.7% of patients. Compared with the ophthalmologist's examination, the Spot had an overall sensitivity of 89.8% and a specificity of 70.4%. Conclusion The Spot achieved good sensitivity and specificity for detection of amblyopia risk factors in this young cohort, particularly in the older subgroup. Our data offer support for automated vision screening in young children.

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.03.014
      Issue No: Vol. 178 (2017)
  • Using Electronic Health Records to Build an Ophthalmologic Data Warehouse
           and Visualize Patients' Data
    • Authors: Karsten U. Kortüm; Michael Müller; Christoph Kern; Alexander Babenko; Wolfgang J. Mayer; Anselm Kampik; Thomas C. Kreutzer; Siegfried Priglinger; Christoph Hirneiss
      Pages: 84 - 93
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Karsten U. Kortüm, Michael Müller, Christoph Kern, Alexander Babenko, Wolfgang J. Mayer, Anselm Kampik, Thomas C. Kreutzer, Siegfried Priglinger, Christoph Hirneiss
      Purpose To develop a near-real-time data warehouse (DW) in an academic ophthalmologic center to gain scientific use of increasing digital data from electronic medical records (EMR) and diagnostic devices. Design Database development. Methods Specific macular clinic user interfaces within the institutional hospital information system were created. Orders for imaging modalities were sent by an EMR-linked picture-archiving and communications system to the respective devices. All data of 325 767 patients since 2002 were gathered in a DW running on an SQL database. A data discovery tool was developed. An exemplary search for patients with age-related macular degeneration, performed cataract surgery, and at least 10 intravitreal (excluding bevacizumab) injections was conducted. Results Data related to those patients (3 142 204 diagnoses [including diagnoses from other fields of medicine], 720 721 procedures [eg, surgery], and 45 416 intravitreal injections) were stored, including 81 274 optical coherence tomography measurements. A web-based browsing tool was successfully developed for data visualization and filtering data by several linked criteria, for example, minimum number of intravitreal injections of a specific drug and visual acuity interval. The exemplary search identified 450 patients with 516 eyes meeting all criteria. Conclusions A DW was successfully implemented in an ophthalmologic academic environment to support and facilitate research by using increasing EMR and measurement data. The identification of eligible patients for studies was simplified. In future, software for decision support can be developed based on the DW and its structured data. The improved classification of diseases and semiautomatic validation of data via machine learning are warranted.

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.03.026
      Issue No: Vol. 178 (2017)
  • Adjuvant Ab Interno Tumor Treatment After Proton Beam Irradiation
    • Authors: Ira Seibel; Aline I. Riechardt; Jens Heufelder; Dino Cordini; Antonia M. Joussen
      Pages: 94 - 100
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Ira Seibel, Aline I. Riechardt, Jens Heufelder, Dino Cordini, Antonia M. Joussen
      Purpose This study was performed to show long-term outcomes concerning globe preservation in uveal melanoma patients after proton beam therapy with the main focus on outcomes according to different adjuvant ab interno surgical procedures. Design Retrospective cohort study. Methods All patients treated with primary proton beam therapy for choroidal or ciliary body melanoma between June 1998 and June 2015 were included. Results A total of 2499 patients underwent primary proton beam therapy, with local tumor control and globe preservation rates of 95.9% and 94.8% after 5 years, respectively. A total of 110 (4.4%) patients required secondary enucleation. Unresponsive neovascular glaucoma was the leading cause of secondary enucleation in 78 of the 2499 patients (3.1%). The 5-year enucleation-free survival rate was 94.8% in the endoresection group, 94.3% in the endodrainage group, and 93.5% in the comparator group. The log-rank test showed P = .014 (comparator group vs endoresection group) and P = .06 (comparator group vs endodrainage-vitrectomy group). Patients treated with endoresection or endodrainage-vitrectomy developed less radiation retinopathy (30.5% and 37.4% after 5 years, P = .001 and P = .048 [Kaplan-Meier], respectively) and less neovascular glaucoma (11.6% and 21.3% after 5 years, P = .001 and P = .01 [Kaplan-Meier], respectively) compared with the comparator group (52.3% radiation retinopathy and 57.8% neovascular glaucoma after 5 years). Conclusion This study suggests that in larger tumors the enucleation and neovascular glaucoma rates might be reduced by adjuvant surgical procedures. Although endoresection is the most promising adjuvant treatment option, the endodrainage-vitrectomy is recommended in patients who are ineligible for endoresection.

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.03.027
      Issue No: Vol. 178 (2017)
  • Patient-Reported Spectacle Independence Questionnaire (PRSIQ): Development
           and Validation
    • Authors: Robert Morlock; R.J. Wirth; Steven R. Tally; Carrie Garufis; Christopher W.D. Heichel
      Pages: 101 - 114
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Robert Morlock, R.J. Wirth, Steven R. Tally, Carrie Garufis, Christopher W.D. Heichel
      Purpose To develop a questionnaire quantifying spectacle independence following cataract surgery. Design Questionnaire design and validation study. Methods A literature review, expert clinical interviews, and patient interviews were undertaken to develop a patient-reported questionnaire assessing spectacle independence. Draft items were assessed and revised in a series of cognitive interviews where the instructions, recall period, and response categories were evaluated for understandability and consistency. The final draft items were evaluated in 2 quantitative studies. Confirmatory factor analyses, including item response theory calibration, were performed; reliability estimates were obtained; and validity analyses of the resulting scores were carried out. Results Qualitative research demonstrated that patients often considered themselves spectacle independent yet, when probed, it was determined that the respondent actually wore correction for certain activities. Moreover, despite what the respondents claimed about needing to wear correction and their actual use of correction, there were various levels of function reported when carrying out activities at several different distances without the use of correction. Using the qualitative results, the Patient-Reported Spectacle Independence Questionnaire (PRSIQ) was developed to assess spectacle independence via items that assess what patients say and do, and how they function at various distances. All quantitative analyses (eg, discriminant and convergent validity correlations, known-groups analyses) conform to predictions and support the use of the PRSIQ as a measure of spectacle independence. Conclusions The PRSIQ is a patient-reported measure assessing spectacle independence following cataract surgery. The analyses conducted provide evidence for the use of the PRSIQ total score as a measure of spectacle independence.

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.03.018
      Issue No: Vol. 178 (2017)
  • Adjustable Bilateral Superior Oblique Tendon Advancement for Bilateral
           Fourth Nerve Palsy
    • Authors: Bashar M. Bata; David A. Leske; Jonathan M. Holmes
      Pages: 115 - 121
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Bashar M. Bata, David A. Leske, Jonathan M. Holmes
      Purpose Bilateral fourth nerve palsy may be symmetric or asymmetric with combined vertical and excylotropic deviations and so there may be an advantage to independent adjustment of vertical and torsional components. We report a surgical technique that allows such independent adjustment. Design Retrospective interventional case series. Methods Fifteen patients, aged 17–73 years, underwent adjustable bilateral superior oblique tendon advancements for bilateral fourth nerve palsy: 11 symmetric (≤2 prism diopters [pd] hyperdeviation in straight-ahead gaze) and 4 asymmetric. Motor alignment was assessed with double Maddox rods and prism and alternate cover tests preoperatively, pre- and postadjustment, and 6 weeks postoperatively. Results Preoperative torsion ranged from 7 to 30 degrees excyclotropia (mean 17 ± 7 degrees) and hyperdeviation from 0 to 10 pd. Preadjustment torsion ranged from 5 degrees excyclotropia to 40 degrees incyclotropia, and hyperdeviation from 0 to 8 pd. Twelve of the 15 patients (80%) were adjusted to a target of 0 pd hyperphoria and 10 degrees incyclotropia (actual mean 9 degrees incyclotropia, range 2–13 degrees incyclotropia). At 6 weeks postoperatively there was expected excyclodrift (to mean 4 degrees excyclotropia, range 0 degrees incyclotropia to 15 degrees excyclotropia), but 13 (87%) had 5 degrees or less excyclotropia and 14 (93%) had 2 pd or less hyperdeviation. Mean torsional correction from preoperative to preadjustment was 31 ± 14 degrees (P < .0001), and from preoperative to 6 weeks was 13 ± 6 degrees (P < .0001). Conclusions Adjustable bilateral superior oblique tendon advancement allows independent control of torsional and vertical components of the deviation, and therefore may be useful in cases of bilateral superior oblique palsy.

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.03.028
      Issue No: Vol. 178 (2017)
  • Rebubbling in Descemet Membrane Endothelial Keratoplasty: Influence of
           Pressure and Duration of the Intracameral Air Tamponade
    • Authors: Daniel Pilger; Ina Wilkemeyer; Jan Schroeter; Anna-Karina B. Maier; Necip Torun
      Pages: 122 - 128
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Daniel Pilger, Ina Wilkemeyer, Jan Schroeter, Anna-Karina B. Maier, Necip Torun
      Purpose To explore the impact of intracameral air tamponade pressure and duration on graft attachment and rebubbling rates. Design A prospective, interventional, nonrandomized study. Methods setting : Department of Ophthalmology, Charité – Universitätsmedizin Berlin. study population : One hundred seventeen patients who underwent Descemet membrane endothelial keratoplasty (DMEK). observation : Intraocular pressure (IOP) at the end of the surgery, immediately after filling the anterior chamber with air, categorized into low (<10 mm Hg), normal (10–20 mm Hg), and high (>20 mm Hg), and the time until partial removal of the air. main outcome measures : Rebubbling rates and endothelial cell density over a 3-month follow-up period analyzed by a multivariable Cox regression model and an analysis of covariance model. Results Thirty-two patients required a rebubbling (27% [95% CI 19%–35%]). Nine patients required more than 1 rebubbling (7% [95% CI 3%–12%]). Compared with normal IOP, lower (HR 8.98 [95% CI 1.07–75.41]) and higher IOP (HR 10.63 [95% CI 1.44–78.27]) increased the risk of requiring a rebubbling (P = .006). Independent of the IOP, an air tamponade duration beyond 2 hours reduced the risk of rebubbling (HR 0.36 [95% CI 0.18–0.71, P = .003]). One month after surgery, the mean endothelial cell loss was 13% (95% CI 2%–25%) and 23% (95% CI 17%–29%) in the group with air tamponade duration of below and above 2 hours, respectively (P = .126). At 3 months after surgery, it was 31% (95% CI 17%–42%) and 42% (95% CI 32%–52%) in the respective groups (P = .229). Conclusions A postsurgical air tamponade of at least 2 hours with an IOP within the physiological range could help to reduce rebubbling rates.

      PubDate: 2017-04-25T09:19:08Z
      DOI: 10.1016/j.ajo.2017.03.021
      Issue No: Vol. 178 (2017)
  • Association of Structural and Functional Measures With Contrast
           Sensitivity in Glaucoma
    • Authors: Nima Fatehi; Sara Nowroozizadeh; Sharon Henry; Anne L. Coleman; Joseph Caprioli; Kouros Nouri-Mahdavi
      Pages: 129 - 139
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Nima Fatehi, Sara Nowroozizadeh, Sharon Henry, Anne L. Coleman, Joseph Caprioli, Kouros Nouri-Mahdavi
      Purpose To test the hypothesis that structural and functional measures predict contrast sensitivity (CS) outcomes in glaucomatous eyes. Design Cross-sectional prospective study. Methods One hundred five eyes of 65 patients who underwent macular spectral-domain optical coherence tomography imaging, 24-2 standard achromatic visual fields (VF), and CS measurement on the same day were enrolled. Association of CS at 4 spatial frequencies (3, 6, 12, and 18 cycles per degree, cpd) with structural and functional outcomes was explored with correlation and regression analyses. Results The median (IQR) 24-2 visual field mean deviation was −7.6 (−11.1 to −3.0). Significant correlations were found between CS at 6 cpd and ganglion cell/inner plexiform layer thickness at inferotemporal and inferonasal macular sectors (ρ = 0.222, P = .023 and ρ = 0.209, P = .032, respectively). CS at 6 cpd demonstrated higher correlations with full macular thickness measurements, the strongest of which was with the central macular thickness in the superior 6 × 3-degree region (ρ = 0.311, P = .001). Contrast sensitivity at 6 cpd also had the strongest correlation with mean deviation of the 4 central VF points (ρ = −0.420; P < .001). There was a significant correlation between logMAR visual acuity and contrast sensitivity at 6, 12, and 18 cpd (ρ = −0.306, ρ = −0.348 and ρ = −0.241, P < .013, respectively). Conclusions Structural and functional measures showed a fair relationship with contrast sensitivity. This association was most prominent between full-thickness macular measures or central VF parameters and CS at 6 cpd. Contrast sensitivity was not a reliable surrogate for glaucoma severity in this cross-sectional study.

      PubDate: 2017-04-25T09:19:08Z
      DOI: 10.1016/j.ajo.2017.03.019
      Issue No: Vol. 178 (2017)
  • Corneal Astigmatism Measurement by Ray Tracing Versus Anterior
           Surface–Based Keratometry in Candidates for Toric Intraocular Lens
    • Authors: Ugo de Sanctis; Piero Donna; Rachele R. Penna; Maria Isabella Calastri; Chiara M. Eandi
      Pages: 1 - 8
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Ugo de Sanctis, Piero Donna, Rachele R. Penna, Maria Isabella Calastri, Chiara M. Eandi
      Purpose To compare corneal astigmatism derived from total corneal refractive power (CATCRP), a ray-tracing method, with that derived from simulated keratometry (CASimK), an anterior surface–based method, in candidates for toric intraocular lens (IOL) implantation. Design Reliability analysis. Methods In 1 eye of 200 consecutive patients (mean age 71 ± 9 years) with cataract, a Pentacam HR (Oculus) was used to measure CATCRP and CASimK. Eyes with CATCRP >1 diopter (D) were defined as candidates for toric IOL implantation. The estimation difference between CATCRP and CASimK was analyzed by calculating the arithmetic, absolute, and vector differences between the 2 methods. Results Seventy-seven candidates were identified. In the candidates, CASimK was <1 D in 22% of cases and underestimated the astigmatism magnitude, on average, by −0.15 ± 0.34 D. The mean absolute and vector difference between CATCRP and CASimK was 0.31 ± 0.29 D and 0.30 ± 0.29 D × 180 degrees, respectively. The absolute and vector differences between the 2 methods were >0.50 D in 21 of 77 (27.2%) and 25 of 77 (32.5%) eyes, respectively; the proportions were significantly (P < .001) higher than in the eyes with CATCRP ≤1 D (0.8% and 9.8%, respectively). The difference in steep meridian alignment between CATCRP and CASimK was >5 degrees in 22.1% and >10 degrees in 2.6% of cases. Conclusion The difference between CATCRP and CASimK, as calculated by Pentacam HR, is greater in candidates for toric IOL implantation than in the general population. That difference considerably influences the candidate and toric IOL power selection in a large proportion of cases.

      PubDate: 2017-03-03T07:12:15Z
      DOI: 10.1016/j.ajo.2017.01.031
      Issue No: Vol. 177 (2017)
  • Local Failure After Episcleral Brachytherapy for Posterior Uveal Melanoma:
           Patterns, Risk Factors, and Management
    • Authors: Claudine Bellerive; Hassan A. Aziz; James Bena; Allan Wilkinson; John H. Suh; Thomas Plesec; Arun D. Singh
      Pages: 9 - 16
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Claudine Bellerive, Hassan A. Aziz, James Bena, Allan Wilkinson, John H. Suh, Thomas Plesec, Arun D. Singh
      Purpose To evaluate the patterns, the risk factors, and the management of recurrence following brachytherapy in patients with posterior uveal melanoma, given that an understanding of the recurrence patterns can improve early recognition and management of local treatment failure in such patients. Design Retrospective cohort study. Methods Setting : Multispecialty tertiary care center. Participants : A total of 375 eyes treated with episcleral brachytherapy for posterior uveal melanoma from January 2004 to December 2014. Exclusion criteria included inadequate follow-up (<1 year) and previous radiation therapy. Main Outcomes and Measures : Local control rate and time to recurrence were the primary endpoints. Kaplan-Meier estimation and Cox proportional hazards models were conducted to identify risk factors for recurrence. Results Twenty-one patients (5.6%) experienced recurrence (follow-up range 12–156 months; median 47 months). The median time to recurrence was 18 months (range 4–156 months). Five-year estimated local recurrence rate was 6.6%. The majority (90.5%) of the recurrences occurred within the first 5 years. The predominant site of recurrence was at the tumor margin (12 patients, 57.1%). Univariate analysis identified 3 statistically significant recurrence risk factors: advanced age, largest basal diameter, and the use of adjuvant transpupillary thermotherapy (TTT). Recurrent tumors were managed by repeat brachytherapy, TTT, or enucleation. Conclusions Local recurrences following brachytherapy are uncommon 5 years after episcleral brachytherapy. Follow-up intervals can be adjusted to reflect time to recurrence. Most of the eyes with recurrent tumor can be salvaged by conservative methods.

      PubDate: 2017-03-03T07:12:15Z
      DOI: 10.1016/j.ajo.2017.01.024
      Issue No: Vol. 177 (2017)
  • Regeneration of Photoreceptor Outer Segments After Scleral Buckling
           Surgery for Rhegmatogenous Retinal Detachment
    • Authors: Eimei Ra; Yasuki Ito; Kenichi Kawano; Takeshi Iwase; Hiroki Kaneko; Shinji Ueno; Shunsuke Yasuda; Keiko Kataoka; Hiroko Terasaki
      Pages: 17 - 26
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Eimei Ra, Yasuki Ito, Kenichi Kawano, Takeshi Iwase, Hiroki Kaneko, Shinji Ueno, Shunsuke Yasuda, Keiko Kataoka, Hiroko Terasaki
      Purpose To investigate the regeneration of the cone outer segments in eyes after surgery for fovea-off rhegmatogenous retinal detachment with an adaptive optics (AO) fundus camera and to correlate these findings with the findings of optical coherence tomography (OCT). Design Retrospective, observational case series. Methods Medical charts of 21 eyes of 21 patients who had undergone surgery for fovea-off rhegmatogenous retinal detachment were retrospectively studied. Cone mosaic images were obtained with an AO fundus camera. Cone packing density at 2 degrees from the fovea within the previously detached area was measured 6 and 12 months after surgery. Retinal thicknesses between the interdigitation zone and the retinal pigment epithelium (IZ-RPE) and between the ellipsoid zone and the retinal pigment epithelium (EZ-RPE) were measured in OCT images. Results Cone density 12 months after surgery was significantly increased from that at 6 months (P = .001), but was still significantly lower than that of normal fellow eyes (P < .001). IZ-RPE and EZ-RPE thickness significantly increased from 6 to 12 months (P = .045, P = .033, respectively), and these values were not significantly different from those of normal fellow eyes. Multivariate analysis showed that cone density at 12 months was significantly associated with IZ-RPE thickness (P = .002), and increases in cone packing density were significantly associated with increases in IZ-RPE thickness (P = .001). Conclusions Recovery of cone packing density measured by AO was associated with structural recovery of the outer retina observed in OCT, suggesting regeneration of the photoreceptor outer segment after surgery.

      PubDate: 2017-03-03T07:12:15Z
      DOI: 10.1016/j.ajo.2017.01.032
      Issue No: Vol. 177 (2017)
  • Defining Outcomes for Clinical Trials of Leber Congenital Amaurosis Caused
           by GUCY2D Mutations
    • Authors: Samuel G. Jacobson; Artur V. Cideciyan; Alexander Sumaroka; Alejandro J. Roman; Jason Charng; Monica Lu; Shreyasi Choudhury; Sharon B. Schwartz; Elise Heon; Gerald A. Fishman; Shannon E. Boye
      Pages: 44 - 57
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Samuel G. Jacobson, Artur V. Cideciyan, Alexander Sumaroka, Alejandro J. Roman, Jason Charng, Monica Lu, Shreyasi Choudhury, Sharon B. Schwartz, Elise Heon, Gerald A. Fishman, Shannon E. Boye
      Purpose To determine outcome measures for a clinical trial of Leber congenital amaurosis (LCA) associated with mutations in the GUCY2D gene. Design Retrospective observational case series. Methods Twenty-eight patients with GUCY2D-LCA (aged 2-59 years) were studied clinically and with chromatic full-field sensitivity testing (FST), optical coherence tomography (OCT), pupillometry, and the NEI Visual Function Questionnaire (VFQ). Results FST permitted quantitation of cone and rod sensitivity in these patients with severe visual impairment. For most patients, the degree of rod and cone sensitivity losses showed a relationship, thereby providing an opportunity to divide patients into cohorts by severity of rod and cone dysfunction. OCT analyses indicated that retinal structure could be used not only as an objective safety measure but also as an exploratory efficacy outcome. A foveal bulge was not present in 67% of patients. The intensity of inner segment/outer segment (ellipsoid zone line) reflectivity was reduced significantly at the fovea and in the rod-dense superior retina. Based on OCT and FST parameters, most patients had dissociation of structure and function. Abnormal pupillometry sensitivity in the majority of GUCY2D-LCA patients provided another objective efficacy outcome. NEI VFQ scores showed a similar range of findings to those of other severe retinal diseases. Conclusion Conventional outcome measures, such as visual acuity and the NEI VFQ, will need to be complemented by methods more specific to this GUCY2D-LCA population. Any therapeutic strategy should determine if there is an effect on rod as well as cone function and structure. FST provides a photoreceptor-based subjective outcome; and OCT in 2 retinal regions, fovea and superior retina, can assess photoreceptor structure. A change in the relationship of structure and function away from baseline becomes evidence of efficacy.

      PubDate: 2017-03-12T16:24:33Z
      DOI: 10.1016/j.ajo.2017.02.003
      Issue No: Vol. 177 (2017)
  • Lymphoma of the Eyelid – An International Multicenter Retrospective
    • Authors: Frederik Holm Svendsen; Peter Kristian Rasmussen; Sarah E. Coupland; Bita Esmaeli; Paul T. Finger; Gerardo F. Graue; Hans E. Grossniklaus; Santosh G. Honavar; Jwu Jin Khong; Penelope A. McKelvie; Kaustubh Mulay; Elisabeth Ralfkiaer; Lene Dissing Sjö; Geeta K. Vemuganti; Bradley A. Thuro; Jeremy Curtin; Steffen Heegaard
      Pages: 58 - 68
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Frederik Holm Svendsen, Peter Kristian Rasmussen, Sarah E. Coupland, Bita Esmaeli, Paul T. Finger, Gerardo F. Graue, Hans E. Grossniklaus, Santosh G. Honavar, Jwu Jin Khong, Penelope A. McKelvie, Kaustubh Mulay, Elisabeth Ralfkiaer, Lene Dissing Sjö, Geeta K. Vemuganti, Bradley A. Thuro, Jeremy Curtin, Steffen Heegaard
      Purpose To document subtype-specific clinical features of lymphoma of the eyelid, and their effect on patient outcome. Design Retrospective observational case series. Methods Patient data were collected from 7 international eye cancer centers from January 1, 1980 through December 31, 2015. The cases included primary and secondary lymphomas affecting the eyelid. Overall survival, disease-specific survival (DSS), and progression-free survival were the primary endpoints. Results Eighty-six patients were included. Mean age was 63 years and 47 (55%) were male. Non-Hodgkin B-cell lymphomas constituted 83% (n = 71) and T-cell lymphomas constituted 17% (n = 15). The most common subtypes were extranodal marginal-zone lymphoma (EMZL) (37% [n = 32]), follicular lymphoma (FL) (23% [n = 20]), diffuse large B-cell lymphoma (DLBCL) (10% [n = 9]), mantle cell lymphoma (MCL) (8% [n = 7]), and mycosis fungoides (MF) (9% [n = 8]). EMZL had a female predilection (69% [22 of 32]), whereas MCL (71% [5 of 7]) and MF (88% [7 of 8]) had a male predominance. MCL (57% [4 of 7]), DLBCL (56% [5 of 9]), and MF (88% [7 of 8]) were frequently secondary lymphomas. Localized EMZL and FL were mostly treated with external beam radiation therapy, whereas DLBCL, MCL, and high Ann Arbor stage EMZL and FL were frequently treated with chemotherapy. DLBCL and MCL had a poor prognosis (5-year DSS, 21% and 50%, respectively), whereas EMZL, FL, and MF had a good prognosis (5-year DSS, 88%, 88% and 86%, respectively). Conclusions Lymphoma of the eyelid consists mainly of the lymphoma subtypes EMZL, FL, DLBCL, MCL, and MF. High-grade DLBCL and MCL, as well as MF, are frequently secondary eyelid lymphomas. The main predictor of outcome was the histologic subtype: EMZL, FL, and MF had a significantly better prognosis than MCL and DLBCL.

      PubDate: 2017-03-12T16:24:33Z
      DOI: 10.1016/j.ajo.2017.02.004
      Issue No: Vol. 177 (2017)
  • Importance of Accommodation and Eye Dominance for Measuring Objective
    • Authors: Yukari Tsuneyoshi; Kazuno Negishi; Kazuo Tsubota
      Pages: 69 - 76
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Yukari Tsuneyoshi, Kazuno Negishi, Kazuo Tsubota
      Purpose To explore factors affecting the difference between objective refractive data measured under monocular closed-field viewing and binocular open-field viewing. Design Prospective observational case series. Methods setting : Institutional. study population : Twenty-nine healthy volunteers (58 eyes; mean age, 38.4 ± 10.0 years; range, 25–60 years). observation procedures : Objective monocular refractions (MR) measured with the Nidek Auto Ref/Keratometer ARK-730A; objective binocular refractions (BR) and objective accommodative amplitude (AA) measured with the Grand Seiko Auto Ref/Keratometer WAM-5500; ocular dominance measured using the hole-in-the-card test; presence and magnitude of far/near (30 cm) phoria evaluated by the cover test and alternating cover test using a prism bar. main outcome measure : The difference between objective refractive data measured under monocular closed-field viewing and binocular open-field viewing. Results The spherical equivalent (SE) of the BR was significantly (P < .001) more hyperopic by 0.51 ± 0.33 diopter (D) than the MR. The difference (BR minus MR) tended to decline with increasing age and decreasing AA (r = −0.231, P = .08; r = 0.223, P = .092, respectively). The correlation between age and difference in SE was significant in dominant eyes (r = −0.372, P = .047) but not in nondominant eyes (r = −0.102, P = .60). In nondominant eyes, the amount of near phoria was correlated significantly (r = 0.403, P = .03) with the difference in SE. The correlation was strong (r = 0.598, P = .01) in 17 subjects with more than 3 D of AA. Conclusions Binocular assessment of refraction is important for precise refractive therapy.

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.02.013
      Issue No: Vol. 177 (2017)
  • Risk of Posterior Capsule Rupture During Cataract Surgery in Eyes With
           Previous Intravitreal Injections
    • Authors: Zaid Shalchi; Mali Okada; Chris Whiting; Robin Hamilton
      Pages: 77 - 80
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Zaid Shalchi, Mali Okada, Chris Whiting, Robin Hamilton
      Purpose To investigate the risk of posterior capsular rupture (PCR) during cataract surgery in eyes with previous intravitreal injection (IVI). Design Retrospective cohort study. Methods The Moorfields Patient Administrative System and OpenEyes electronic databases were used to study all cataract surgery procedures undertaken between January 1, 2012 and August 31, 2015 in the Moorfields main and satellite sites. Clinical data were anonymized and extracted, including prior occurrence and number of intravitreal injections. Logistic regression was performed with the Hosmer-Lemeshow test for goodness of fit to generate odds ratios for possible risk factors. Results In total, 62 994 cataract surgery procedures were undertaken over the study period, of which 1035 (1.64%) were in eyes with previous intravitreal injection(s). PCR occurred in 650 (1.04%) eyes. After logistic regression, prior intravitreal injection was associated with an increased risk of PCR (P = .037), with an odds ratio of 1.66. The number of prior injections, indication for injections, and service undertaking the surgery were not associated with increased risk of PCR (P > .1). Conclusions Eyes with previous IVI have a higher risk of PCR. This is not affected by number of previous injections, indication for injections, or the specialty undertaking the surgery.

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.02.006
      Issue No: Vol. 177 (2017)
  • Visual Function 20 Years After Childhood Hemispherectomy for Intractable
    • Authors: Sian E. Handley; Faraneh Vargha-Khadem; Richard J. Bowman; Alki Liasis
      Pages: 81 - 89
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Sian E. Handley, Faraneh Vargha-Khadem, Richard J. Bowman, Alki Liasis
      Purpose To investigate visual function in adults post hemispherectomy in childhood. Design Noncomparative case series. Methods All participants underwent visual acuity, binocular function, visual field, optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL), and monocular pattern reversal visually evoked potentials (prVEP). Participants : Six adults who had a hemispherectomy in childhood (median 21.5 years postoperative). Main Outcome Measures : Comparison was made of visual acuity, visual field height, global RNFL thickness, and prVEP amplitude evoked by full- and half-field stimulation. Comparison of the eye ipsilateral to the side of surgery to the contralateral eye was achieved employing paired t tests to the visual function measures. Results All participants had homonymous hemianopia. The residual seeing visual field was constricted in all cases when compared with normative data despite crossing the midline into the blind hemifield in 11 of 12 eyes. This observation was supported by prVEP to stimuli presented in the blind half field. The height of the visual field was smaller in the eye contralateral to the side of surgery compared with the ipsilateral side (P = .047). Visual acuity and RNFL thickness also showed greater diminution in the contralateral eye (P = .040 and P = .0004). Divergent strabismus was found in 4 participants with greater field loss. Conclusions Adults post hemispherectomy in childhood may have better visual function in the eye ipsilateral to the side of the hemispherectomy compared with the contralateral eye. Possible mechanisms of the interocular difference are discussed. Though visual fields and prVEP responses demonstrate evidence of reorganization into the blind half field, they also reveal significant unexpected constriction of the functional field.

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.02.014
      Issue No: Vol. 177 (2017)
  • Evaluation of Macular Vascular Abnormalities Identified by Optical
           Coherence Tomography Angiography in Sickle Cell Disease
    • Authors: Ian C. Han; Mongkol Tadarati; Katia D. Pacheco; Adrienne W. Scott
      Pages: 90 - 99
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Ian C. Han, Mongkol Tadarati, Katia D. Pacheco, Adrienne W. Scott
      Purpose To evaluate macular vascular flow abnormalities identified by optical coherence tomography angiography (OCT-A) in patients with various sickle cell genotypes. Design Prospective, observational case series. Methods This is a single-institution case series of adult patients with various sickle cell genotypes. All patients underwent macular OCT-A (Avanti RTVue XR). Images were analyzed qualitatively for areas of flow loss and quantitatively for measures of foveal avascular area, parafoveal flow, and vascular density. The findings were compared by sickle cell genotype and retinopathy stage and correlated to retinal thickness and visual acuity. Results OCT-A scans of 82 eyes from 46 patients (60.9% female, mean age 33.5 years) were included. Sickle cell genotypes included 27 patients with hemoglobin SS (58.7%), 14 SC (30.4%), 4 beta-thalassemia (8.7%), and 1 sickle trait (2.2%). Discrete areas of flow loss were noted in 37.8% (31/82) of eyes overall and were common in both SS (40.0%, 20/50 eyes) and SC (41.7%, 10/24 eyes). Flow loss was more extensive in the temporal and nasal parafoveal subfields of the deep plexus with sickle SC or proliferative retinopathy. Retinal thickness measurements correlated with vascular density of the fovea, parafovea, and temporal and superior subfields. Visual acuity correlated with foveal avascular zone area and parafoveal vascular density in the superficial and deep plexi. Conclusions Areas of abnormal macular vascular flow are common in patients with various sickle cell genotypes. These areas may be seen at any retinopathy stage but may be more extensive with sickle SC or proliferative retinopathy.

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.02.007
      Issue No: Vol. 177 (2017)
  • Outcomes After Superior Rectus Transposition and Medial Rectus Recession
           Versus Vertical Recti Transposition for Sixth Nerve Palsy
    • Authors: Yeon-Hee Lee; Scott R. Lambert
      Pages: 100 - 105
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Yeon-Hee Lee, Scott R. Lambert
      Purpose To compare the effectiveness of superior rectus transposition and medial rectus recession (SRT/MRc) vs inferior and superior rectus transposition (VRT) for acquired sixth nerve palsy. Design Consecutive, interventional case series. Methods The medical records of a consecutive series of patients with acquired sixth nerve palsy who underwent VRT or SRT/MRc by a single surgeon were reviewed. The preoperative and postoperative findings were compared between the 2 groups. Results Eight patients (mean age, 46.8 years) underwent SRT/MRc and 8 patients underwent VRT (mean age, 51.1 years). Lateral fixation was performed on all but 4 patients in the VRT group. Preoperative esotropia in primary position and abduction deficit were similar in both groups (SRT/MRc, 41.9 prism diopter [PD], −4.6; VRT, 55.6 PD, −4.5; P = .195, 1.0). The SRT/MRc group underwent a mean MR recession of 6 (range, 5–7) mm. Four patients in the VRT later underwent MR recession (mean 5.3 mm, range 5–6 mm). In addition, 5 patients in the VRT group had 1 or more botulinum toxin injections in the medial rectus muscle. No additional procedures were performed in the SRT/MR group. Fewer additional procedures were performed with SRT/MR (SRT/MR, 0; VRT, 1.8 ± 1.2; P < .010). At last follow-up, residual esotropia (SRT/MRc, 7.1 PD; VRT, 10.3 PD; P = .442) was similar in both groups, but abduction was better in the SRT/MRc group (SRT/MR, −3.0 ± 0.7; VRT, −3.8 ± 0.4; P = .038). There were no new persistent vertical deviations or torsional diplopia. Conclusions Final outcomes were similar with SRT/MRc vs VRT. However, fewer additional surgical procedures were needed with SRT/MR.

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.02.019
      Issue No: Vol. 177 (2017)
  • Vessel Density and Structural Measurements of Optical Coherence Tomography
           in Primary Angle Closure and Primary Angle Closure Glaucoma
    • Authors: Harsha L. Rao; Zia S. Pradhan; Robert N. Weinreb; Mohammed Riyazuddin; Srilakshmi Dasari; Jayasree P. Venugopal; Narendra K. Puttaiah; Dhanaraj A.S. Rao; Sathi Devi; Kaweh Mansouri; Carroll A.B. Webers
      Pages: 106 - 115
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Harsha L. Rao, Zia S. Pradhan, Robert N. Weinreb, Mohammed Riyazuddin, Srilakshmi Dasari, Jayasree P. Venugopal, Narendra K. Puttaiah, Dhanaraj A.S. Rao, Sathi Devi, Kaweh Mansouri, Carroll A.B. Webers
      Purpose To evaluate the vessel density measurements of the optic nerve head (ONH), peripapillary, and macular regions on optical coherence tomography (OCT) angiography in eyes with primary angle closure (PAC) and primary angle closure glaucoma (PACG), and to compare their diagnostic abilities with the ONH rim area, peripapillary retinal nerve fiber layer (RNFL) thickness, and the macular ganglion cell complex (GCC) thickness measurements on OCT in PACG. Design Cross-sectional study. Methods Seventy-seven eyes of 50 control subjects, 65 eyes of 45 patients with PACG, and 31 eyes of 22 PAC patients with a history of high intraocular pressure underwent imaging with OCT. Area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities of vessel densities were compared with structural measurements. Results All the vessel density and structural measurements were significantly lower (P < .05) in the PACG compared with the control group. Vessel densities in the PAC were similar (P > .05) to that of the controls; the superotemporal RNFL, however, was significantly thinner in the PAC group (127 μm vs 135 μm, P = .01). The AUC and sensitivity at 95% specificity of vessel densities within the ONH (0.76 and 42%) and macular region (0.69 and 18%) in PACG were significantly lower P < .001) than ONH rim area (0.90 and 77%) and GCC thickness (0.91 and 55%), respectively. AUC and sensitivity of peripapillary vessel density (0.85 and 53%) were similar (P = 0.25) to RNFL thickness (0.91 and 65%). Conclusions These results suggest that structural changes in PACG occur earlier than the reduction in retinal vessel densities.

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.02.020
      Issue No: Vol. 177 (2017)
  • Association of Disorganization of Retinal Inner Layers With Visual Acuity
           In Eyes With Uveitic Cystoid Macular Edema
    • Authors: Dilraj S. Grewal; Matthew L. O'Sullivan; Martina Kron; Glenn J. Jaffe
      Pages: 116 - 125
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Dilraj S. Grewal, Matthew L. O'Sullivan, Martina Kron, Glenn J. Jaffe
      Purpose To determine whether disorganization of retinal inner layers (DRIL) assessed by spectral-domain optical coherence tomography (SDOCT) correlates with visual acuity (VA) in eyes with uveitic cystoid macular edema (CME). Design Secondary analysis of randomized clinical trial data. Methods Fifty-six eyes of 42 patients with uveitic CME were prospectively imaged as part of the VISUAL-1 trial ( identifier NCT01138657). Central subfield thickness (CFT), horizontal and vertical extent of DRIL, foveal DRIL (>500 μm DRIL) hyperreflective foci (HRF), average and largest area of intraretinal (IR) cysts, and extent of disruption of external limiting membrane (ELM) and ellipsoid zone (EZ) were determined within the 1-mm central subfield and correlated with VA at baseline and follow-up visits. Results Regression analysis adjusted for clustered observations was used to examine the association between OCT morphologic parameters and VA. Across all visits (n = 168), significant associations were found for CFT (0.080 per 100 μm, P < .001), foveal DRIL (0.170, P < .001), horizontal DRIL length (0.055 per 100 μm, P < .001), vertical DRIL extent (0.001, P = .005), total area of IR cysts (0.204 per mm2, P < .001), area of largest IR cyst (1.407 per mm2, P < .001), presence of HRF (P = .026), and EZ disruption (0.042 per 100 μm, P = .02). ELM disruption did not show a significant association with VA (−0.013 per 100 μm, P = .61). Conclusion DRIL is a robust and easily obtained surrogate marker of VA in participants with current or resolved uveitic CME. CFT, DRIL, IR cyst area, EZ disruption, and HRF had a strong association with VA.

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.02.017
      Issue No: Vol. 177 (2017)
  • Inferior Rectus Transposition: A Novel Procedure for Abducens Palsy
    • Authors: Federico G. Velez; Melinda Y. Chang; Stacy L. Pineles
      Pages: 126 - 130
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Federico G. Velez, Melinda Y. Chang, Stacy L. Pineles
      Purpose Superior rectus transposition has been popularized for the treatment of abduction deficiencies. Potential complications include induced vertical deviation and torsion. A new procedure, the inferior rectus transposition (IRT), may be similarly beneficial for patients at risk for postoperative vertical deviation or incyclotropia. The purpose of this study is to describe the outcomes of patients undergoing IRT. Design Prospective, interventional case series. Methods Five patients in an academic pediatric ophthalmology and strabismus practice with a complete lateral rectus palsy who underwent IRT were studied. Changes in anomalous head posture, ocular rotations, ocular alignment, and torsion preoperatively to postoperatively were compared. Results The patients ranged in age from 19–89 years. There was a significant correction in the angle of esotropia (ET) from 39±17Δ (14–55Δ) to 12 ± 9.8Δ (0–22Δ) postoperatively (P = .02). Two of 5 patients had preoperative hypertropia of the affected eye (1.4 ± 2.2Δ; range, 2–5Δ). One of those had no vertical deviation postoperatively and 1 patient resulted in 2Δ hypotropia. One patient without vertical misalignment preoperatively developed a small postoperative vertical deviation. Torticollis significantly improved from 31.4 ± 11.6° to 5 ± 5.8° (P = .004). All patients improved abduction, with a mean of −4.4 ± 0.5 preoperatively to −3.4 ± 0.9 postoperatively (P = .07). Conclusion Initial postoperative follow-up in patients with abducens palsy undergoing IRT shows a significant improvement in ocular alignment and torticollis. In patients with preoperative hypertropia, IRT resulted in a downward shifting effect on the operated eye. IRT may be a beneficial procedure for patients with preoperative hypertropia or intorsion requiring transposition procedures. Future studies with larger populations and longer durations of follow-up will be required before this procedure can be recommended.

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.02.021
      Issue No: Vol. 177 (2017)
  • En Face Optical Coherence Tomography Analysis to Assess the Spectrum of
           Perivenular Ischemia and Paracentral Acute Middle Maculopathy in Retinal
           Vein Occlusion
    • Authors: Khalil Ghasemi Falavarjani; Nopasak Phasukkijwatana; K. Bailey Freund; Emmett T. Cunningham; Ananda Kalevar; H. Richard McDonald; Rosa Dolz-Marco; Philipp K. Roberts; Irena Tsui; Richard Rosen; Lee M. Jampol; Srinivas R. Sadda; David Sarraf
      Pages: 131 - 138
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Khalil Ghasemi Falavarjani, Nopasak Phasukkijwatana, K. Bailey Freund, Emmett T. Cunningham, Ananda Kalevar, H. Richard McDonald, Rosa Dolz-Marco, Philipp K. Roberts, Irena Tsui, Richard Rosen, Lee M. Jampol, Srinivas R. Sadda, David Sarraf
      Purpose To assess the spectrum of perivenular ischemia in eyes with retinal vascular obstruction (typically central or hemicentral retinal vein obstruction) using en face optical coherence tomography (OCT). Design Retrospective observational case series. Methods Eyes with recent retinal vascular occlusion illustrating paracentral acute middle maculopathy (PAMM) in a perivenular fern-like pattern with en face OCT were evaluated in this study. Multimodal retinal imaging including en face OCT segmentation of the inner nuclear layer was performed in all patients. Color fundus photography and fluorescein angiography (FA) images were used to create a vascular overlay of the retinal veins vs the retinal arteries to map the distribution of PAMM with en face OCT analysis. Results Multimodal retinal imaging was performed in 11 eyes with acute retinal vascular obstruction. While 7 eyes demonstrated obvious findings of retinal vein obstruction (5 with central and 2 with hemicentral retinal vein occlusion), 4 eyes were unremarkable at presentation. En face OCT analysis demonstrated a spectrum of perivenular PAMM illustrating a fern-like pattern with sparing of the periarteriolar area in all cases. Conclusion En face OCT may illustrate a remarkable perivenular pattern of PAMM in eyes with retinal vascular obstruction even in the absence of significant funduscopic findings. Perivenular PAMM with en face OCT demonstrates a wide spectrum of variation with narrow fern-like perivenular lesions at the mildest end and more diffuse lesions with only periarterial sparing at the most severe end of the spectrum. Arterial hypoperfusion secondary to outflow obstruction from a central retinal vein obstruction appears to be the most common cause of this presentation, although primary arterial hypoperfusion may also be an etiology.

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.02.015
      Issue No: Vol. 177 (2017)
  • Risk Factors for the Development of Cataract in Children with Uveitis
    • Authors: Tamar Blum-Hareuveni; Sophie Seguin-Greenstein; Michal Kramer; Guy Hareuveni; Yael Sharon; Ronit Friling; Lazha Sharief; Sue Lightman; Oren Tomkins-Netzer
      Pages: 139 - 143
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Tamar Blum-Hareuveni, Sophie Seguin-Greenstein, Michal Kramer, Guy Hareuveni, Yael Sharon, Ronit Friling, Lazha Sharief, Sue Lightman, Oren Tomkins-Netzer
      Purpose To determine the risk factors for the development of cataract in children with uveitis of any etiology. Design Cohort study. Methods Two hundred forty-seven eyes of 140 children with uveitis were evaluated for the development of vision-affecting cataract. Demographic, clinical, and treatment data were collected between the time of presentation and the first instance cataract was recorded or findings at final follow-up. Main outcome measures included the prevalence of cataract and distribution by type of uveitis, incidence of new onset cataract time to cataract development, and risk factors for the development of cataract. Results The prevalence of cataract in our cohort was 44.2% and was highest among eyes with panuveitis (77.1%), chronic anterior uveitis (48.3%), and intermediate uveitis (48.0%). The overall incidence of newly diagnosed cataract was 0.09 per eye-year, with an estimated 69% to develop uveitis-related cataract with time. The main factors related with cataract development were the number of uveitis flares per year (hazard ratio [HR] = 3.06 [95% confidence interval {CI}, 2.15–4.35], P < .001), cystoid macular edema (HR = 2.87 [95% CI, 1.41–5.82], P = .004), posterior synechia at presentation (HR = 2.85 [95% CI, 1.53–5.30], P = .001), and use of local injections of corticosteroids (HR = 2.37 [95% CI, 1.18–4.75], P = .02). Treatments with systemic and topical corticosteroids were not significant risk factors. Conclusions In this study, we found that development of cataract is common among pediatric eyes with uveitis and is most strongly related to the extent of inflammation recurrences and ocular complications. We suggest that controlling the inflammation, even using higher doses of systemic and topical corticosteroids, is of importance in preventing ocular complications, such as cataract.

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.02.023
      Issue No: Vol. 177 (2017)
  • Biometry Characteristics in Adults and Children With Marfan Syndrome: From
           the Marfan Eye Consortium of Chicago
    • Authors: Michael Kinori; Sarah Wehrli; Iris S. Kassem; Nathalie F. Azar; Irene H. Maumenee; Marilyn B. Mets
      Pages: 144 - 149
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Michael Kinori, Sarah Wehrli, Iris S. Kassem, Nathalie F. Azar, Irene H. Maumenee, Marilyn B. Mets
      Purpose To report on the biometric findings of adults and children with Marfan syndrome (MFS) recruited from 2 annual National Marfan Foundation conferences (2012 and 2015). Design Cross-sectional study. Methods Subjects diagnosed with MFS by Ghent 2 nosology were included for analysis. Subjects were divided into “adults” (≥16 years of age) and “children” (5–15 years of age). Biometric data included values for refractive error, axial length (AL), corneal curvature, anterior chamber depth, lens thickness, and central corneal thickness. Results Of the 117 subjects evaluated, 74 (35 adults, 32 children, and 7 children <5 years of age) had a definite diagnosis of MFS and were included in the study. The AL was longer (25.25 ± 0.32 mm vs 24.24 ± 0.33 mm, P = .03) and the lens was thicker (3.94 ± 0.09 mm vs 3.62 ± 0.10 mm, P = .03) in adults. Both groups had flat corneas (average keratometry [Kmed] of 41.59 ± 0.35 diopters [D] in adults vs 40.89 ± 0.36 D in children, P = .17). A negative correlation was found between AL and Kmed (−0.33, P < .001). The corneas of patients with MFS with ectopia lentis (EL) were significantly flatter and with higher degree of corneal astigmatism compared to patients without EL (Kmed of 40.68 ± 0.31 D vs 41.75 ± 0.28 D, P < .01 and corneal astigmatism of 1.68 ± 0.16 D vs 1.13 ± 0.14 D, P = .01). Conclusions Children with established MFS have flat corneas at least to the same degree as adults. Corneas of patients with MFS with EL are flatter and have a higher degree of corneal astigmatism. We strongly suggest that corneal parameters should be measured if MFS is suspected, especially in children that may not yet have developed EL.

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.02.022
      Issue No: Vol. 177 (2017)
  • Gene Therapy in Neovascular Age-related Macular Degeneration: Three-Year
           Follow-up of a Phase 1 Randomized Dose Escalation Trial
    • Authors: Ian J. Constable; Chooi-May Lai; Aaron L. Magno; Martyn A. French; Samuel B. Barone; Steven D. Schwartz; Mark S. Blumenkranz; Mariapia A. Degli-Esposti; Elizabeth P. Rakoczy
      Pages: 150 - 158
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Ian J. Constable, Chooi-May Lai, Aaron L. Magno, Martyn A. French, Samuel B. Barone, Steven D. Schwartz, Mark S. Blumenkranz, Mariapia A. Degli-Esposti, Elizabeth P. Rakoczy
      Purpose To assess the safety of rAAV.sFlt-1 subretinal injection in neovascular age-related macular degeneration (wet AMD) over 36 months. Design Phase 1 dose escalation trial. Methods Eight subjects with advanced, treatment-experienced wet AMD were randomly assigned (3:1) to treatment and non–gene therapy control groups. Eligible subjects were ≥65 years, had wet AMD, and had best-corrected visual acuity (BCVA) 10/200 to 20/80 in the study eye and 20/200 or better in the other eye. Three of the treatment group subjects received low-dose (1 × 1010 vector genomes) and 3 high-dose (1 × 1011 vector genomes) rAAV.sFLT-1 via subretinal injection. Study monitoring was monthly to the primary endpoint at month 12 and then protocol-driven follow-up study visits were conducted at months 18 and 36. All subjects received intravitreal ranibizumab at baseline and at week 4, and retreatment injections at subsequent visits based on prespecified criteria for active wet AMD. The primary endpoint was ocular and systemic safety, but exploratory data including BCVA, retinal center point thickness, and the number of ranibizumab retreatments at and between study visits were also analyzed. Results Six of the 8 subjects completed the 36-month study. Subretinal injection with pars plana vitrectomy was well tolerated in this cohort. No ocular or systemic safety signals were observed during the long-term follow-up period. Exploratory data analysis suggests stability of wet AMD over the 36-month period. Conclusions Subretinal delivery of rAAV.sFLT-1 was well tolerated and demonstrated a favourable safety profile through month 36. Thus, rAAV.sFLT-1 could be safely considered for future evaluation in the treatment of wet AMD.

      PubDate: 2017-03-27T16:03:12Z
      DOI: 10.1016/j.ajo.2017.02.018
      Issue No: Vol. 177 (2017)
  • Impact of Retinitis Pigmentosa on Quality of Life, Mental Health, and
           Employment Among Young Adults
    • Authors: Anne Elisabeth Chaumet-Riffaud; Philippe Chaumet-Riffaud; Anaelle Cariou; Céline Devisme; Isabelle Audo; José-Alain Sahel; Saddek Mohand-Said
      Pages: 169 - 174
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Anne Elisabeth Chaumet-Riffaud, Philippe Chaumet-Riffaud, Anaelle Cariou, Céline Devisme, Isabelle Audo, José-Alain Sahel, Saddek Mohand-Said
      Purpose To determine the relationship between visual function and quality of life, education, mental health, and employment among young adults with retinitis pigmentosa (RP). Design Cross-sectional study. Methods Inclusion of 148 patients (mean age 38.2 ± 7.1 years) diagnosed with RP, living in France. Quality of life was assessed using the National Eye Institute Visual Function Questionnaire (VFQ-25), mental state with the Hospital and Anxiety and Depression Scale (HADS), and employment with a specifically designed questionnaire. Results Limited visual impairment was noted in 22.3%, low vision in 29.7%, and legal blindness in 48.0%. There was a correlation between quality-of-life scores and residual visual field (P < .0001). Mental health scores were suggestive of anxiety in 36.5% and depression in 15.5%. The rates did not increase with disability level (P = .738, P = .134). The percentage of subjects with higher education did not significantly decrease with disability level (P = .113). The employment rate did not significantly decrease with disability level (P = .276). It was lower in subjects reporting depression (P = .0414). Self-rated impact of RP on employment increased with disability level (P = .02642). Conclusions Our results differ from previous results showing lower education rates and employment rates in young adults with RP. Further research is warranted focusing on the impact of mental health, education, workplace conditions, and employment aids on employment rate vs age- and education-matched normally sighted controls to guide visual disability strategies in RP.

      PubDate: 2017-03-27T16:03:12Z
      DOI: 10.1016/j.ajo.2017.02.016
      Issue No: Vol. 177 (2017)
  • Aqueous Humor Cytokines in Patients With Acute Nonarteritic Anterior
           Ischemic Optic Neuropathy
    • Authors: Jonathan A. Micieli; Cindy Lam; Kinda Najem; Edward A. Margolin
      Pages: 175 - 181
      Abstract: Publication date: Available online 21 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Jonathan A. Micieli, Cindy Lam, Edward A. Margolin, Kinda Najem

      PubDate: 2017-04-25T09:19:08Z
      DOI: 10.1016/j.ajo.2017.03.003
      Issue No: Vol. 177 (2017)
  • Aqueous Humor Cytokines in Patients With Acute Nonarteritic Anterior
           Ischemic Optic Neuropathy
    • Authors: Jonathan A. Micieli; Cindy Lam; Kinda Najem; Edward A. Margolin
      Pages: 175 - 181
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Jonathan A. Micieli, Cindy Lam, Kinda Najem, Edward A. Margolin
      Purpose To measure and compare the cytokine concentrations in the aqueous humor of patients with acute nonarteritic anterior ischemic optic neuropathy (NAION) and normal age-related cataract controls. Design Prospective, comparative observational study. Methods Aqueous humor samples were obtained in 10 patients with acute NAION (within 14 days of symptom onset) and 15 control patients with age-related cataract. The levels of 6 cytokines—vascular endothelial growth factor (VEGF), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-2, IL-6, and IL-8—were determined using a multiplex bead immunoassay. The clinical characteristics of patients were also collected for correlation analysis. Results The mean concentration of VEGF (94.1 ± 40.4 pg/mL) was significantly higher in the NAION group compared to the cataract controls (52.2 ± 20.8 pg/mL; P = .010) and the mean concentration of IL-2 (5.56 ± 1.27 pg/mL) was significantly lower in the NAION group than in the cataract controls (16.6 ± 14.0 pg/mL; P = .002). There were no differences in the concentration of TNF-α, IL-1β, IL-6, and IL-8. There was a strong negative correlation between the VEGF concentration and the peripapillary retinal nerve fiber layer (RNFL) thickness at presentation (r = −0.657, P = .055). There was no significant correlation between the RNFL thickness and any other cytokines, the mean deviation on 24-2 Humphrey visual fields, or the duration of vision loss. Conclusions Acute NAION is associated with higher VEGF and lower IL-2 concentrations without a change in other inflammatory cytokines. This has implications for future therapeutic interventions and diagnostic testing in patients with this acute optic neuropathy.

      PubDate: 2017-03-27T16:03:12Z
      DOI: 10.1016/j.ajo.2017.03.003
      Issue No: Vol. 177 (2017)
  • Interferon-alpha2a and Systemic Corticosteroid in Monotherapy in Chronic
           Uveitis: Results of the Randomized Controlled BIRDFERON Study
    • Authors: Christine Fardeau; Anne Simon; Benoît Rodde; Fabiana Viscogliosi; Pierre Labalette; Vincent Looten; Sophie Tézenas du Montcel; Phuc LeHoang
      Pages: 182 - 194
      Abstract: Publication date: May 2017
      Source:American Journal of Ophthalmology, Volume 177
      Author(s): Christine Fardeau, Anne Simon, Benoît Rodde, Fabiana Viscogliosi, Pierre Labalette, Vincent Looten, Sophie Tézenas du Montcel, Phuc LeHoang
      Purpose Macular edema is the leading cause of vision loss in bilateral chronic noninfectious posterior uveitis, and is currently being treated using corticosteroids, immunosuppressive agents, and biotherapies. The aim of this trial was to assess and compare the efficacy and safety of corticosteroids and interferon-α (IFN-α) in adults with such conditions. Design Randomized controlled trial. Methods Subjects : Adult patients with bilateral posterior autoimmune noninfectious and nontumoral uveitis complicated by macular edema in at least 1 eye. Intervention : Patients received either subcutaneous IFN-α2a, systemic corticosteroids, or no treatment for 4 months. The efficacy and safety were assessed for up to 4 months. Main Outcome Measures : The main endpoint was the change of the central foveal thickness (CFT) obtained by optical coherence tomography. Results Forty-eight patients were included. In intention-to-treat analysis, the median CFT change showed no significant difference. However, the per-protocol analysis showed a significant difference between groups for both eyes (OD and OS), and for the worse and better eyes. Statistically significant difference was found between the control and corticosteroid groups for the OD (P = .0285), and between the control and IFN-α groups for the OD (P = .0424) and worse eye (P = .0354). Serious adverse events occurred in 2 patients in the IFN group, in 1 patient in the corticosteroid group, and in 2 patients in the control group and were completely resolved after switch. Conclusions IFN-α and systemic corticosteroids, compared with no treatment, were associated with significant anatomic and visual improvement shown in the per-protocol study.

      PubDate: 2017-04-04T08:37:22Z
      DOI: 10.1016/j.ajo.2017.03.001
      Issue No: Vol. 177 (2017)
  • Obituary
    • Authors: William Benson
      Abstract: Publication date: Available online 24 April 2017
      Source:American Journal of Ophthalmology
      Author(s): William E. Benson

      PubDate: 2017-04-25T09:19:08Z
  • Anterior Chamber Angle and Anterior Segment Structure of Eyes in Children
           with Early Stages of Retinopathy of Prematurity
    • Authors: Shirley HL. Chang; Yung-Sung Lee; Shiu-Chen Wu; Lai-Chu See; Chia-Chi Chung; Meng-Lin Yang; Chi-Chun Lai; Wei-Chi Wu
      Abstract: Publication date: Available online 24 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Shirley HL. Chang, Yung-Sung Lee, Shiu-Chen Wu, Lai-Chu See, Chia-Chi Chung, Meng-Lin Yang, Chi-Chun Lai, Wei-Chi Wu
      Purpose To compare structural differences in the anterior chamber angle (ACA) and related optic components in children with or without retinopathy of prematurity (ROP). Design Prospective cross-sectional study. Methods Setting: A referred medical center in Taiwan. Study Population: The patients included preterm children with a history of ROP who had undergone laser therapy. The controls included age-matched healthy full-term children. Observation Procedure: The ACA structures were evaluated using gonioscopy. Main Outcome Measures: The angularity of the anterior chamber and associated anatomical changes. Results We examined 54 eyes of 29 preterm children with ROP and 134 eyes of 67 children born at term. The eyes of the ROP children exhibited a narrower ACA, steeper iris curvature, and more anteriorly inserted iris than those of the full-term children (P < .001, = .002, and = .08, respectively). The eyes of the ROP children also exhibited steeper corneas, shallower anterior chamber depths, thicker lenses, and higher degrees of refractive errors (all P < .001) than those of the full-term children. The axial lengths (AL) did not differ between the two groups (P = .15). Conclusions The eyes of the ROP children presented a narrower ACA and a more anteriorly curved and inserted iris than those of the full-term children. A steeper cornea, shallower anterior chamber, and greater lens thickness were the main structural changes in the anterior segment components of these patients. Further research is needed to investigate the association between these structural changes and the development of certain ocular diseases, such as glaucoma, in these patients.

      PubDate: 2017-04-25T09:19:08Z
      DOI: 10.1016/j.ajo.2017.04.010
  • Sensitivity and Specificity of Laser-scanning In Vivo Confocal Microscopy
           for Filamentous Fungal Keratitis: Role of Observer Experience
    • Authors: Ahmad Kheirkhah; Zeba A. Syed; Vannarut Satitpitakul; Sunali Goyal; Rodrigo Müller; Elmer Y. Tu; Reza Dana
      Abstract: Publication date: Available online 23 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Ahmad Kheirkhah, Zeba A. Syed, Vannarut Satitpitakul, Sunali Goyal, Rodrigo Müller, Elmer Y. Tu, Reza Dana
      Purpose To determine sensitivity and specificity of laser-scanning in vivo confocal microscopy (LS-IVCM) for detection of filamentous fungi in patients with microbial keratitis and to evaluate the effect of observer’s imaging experience on these parameters. Design Retrospective, reliability study Methods This study included 21 patients with filamentous fungal keratitis and 24 patients with bacterial keratitis (as controls). The etiology of infection was confirmed based on the response to specific therapy regardless of culture results. All patients had undergone full-thickness corneal imaging by a LS-IVCM (Heidelberg Retina Tomograph 3 with Rostock Cornea Module). The images were evaluated for the presence of fungal filaments by 2 experienced observers and 2 inexperienced observers. All observers were masked to the clinical and microbiologic data. Results Mean number of images obtained per eye was 917 ± 353. The average sensitivity of LS-IVCM for detecting fungal filaments was 71.4 ± 0% for the experienced observers and 42.9 ± 6.7% for the inexperienced observers. The average specificity was 89.6 ± 3.0% and 87.5 ± 17.7% for these two groups of observers, respectively. Although there was a good agreement between two experienced observers (κ=0.77), the inexperienced observers showed only a moderate interobserver agreement (κ=0.51). The LS-IVCM sensitivity was higher in patients with fungal infections who had positive culture or longer duration of the disease. Conclusions While LS-IVCM has a high specificity for diagnosing fungal keratitis, its sensitivity is moderate and highly dependent on the level of the observer’s experience and training with this imaging modality.

      PubDate: 2017-04-25T09:19:08Z
      DOI: 10.1016/j.ajo.2017.04.011
  • Experience With a Subretinal Cell-based Therapy in Patients With
           Geographic Atrophy Secondary to Age-related Macular Degeneration
    • Authors: Allen C. Ho; Tom S. Chang; Michael Samuel; Paul Williamson; Robert F. Willenbucher; Terri Malone
      Abstract: Publication date: Available online 21 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Allen C. Ho, Tom S. Chang, Michael Samuel, Paul Williamson, Robert F. Willenbucher, Terri Malone
      Purpose To evaluate the safety and tolerability of and clinical response to a single, subretinal dose of human umbilical tissue–derived cells (palucorcel [CNTO-2476]) in the eyes of adults aged ≥50 years with bilateral geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Design Phase 1/2a, multicenter, open-label, dose-escalation, fellow-eye–controlled study. Methods In the phase 1 portion, eyes were assigned to receive a single, subretinal dose of palucorcel (ranging from 6.0 × 104 to 5.6 × 105 viable cells). In the phase 2a portion, eyes were assigned to one of 2 palucorcel doses (6.0 × 104 or 3.0 × 105 cells) determined during the phase 1 portion. The intervention eye was the eye with worse baseline visual acuity. Results A total of 35 eligible subjects underwent at least a partial surgical procedure. Palucorcel was administered in 33 eyes. Overall, 17.1% (6/35) of subjects experienced retinal detachments and 37.1% (13/35) experienced retinal perforations. No episodes of immune rejection or tumor formation were observed. At 1 year, ≥10- and ≥15-letter gains in BCVA were observed in 34.5% (10/29) and 24.1% (7/29) of eyes receiving palucorcel, respectively, and in 3.3% (1/30; for both) of fellow eyes. Conclusions The subretinal delivery procedure in this study was associated with a high rate of retinal perforations (n = 13) and retinal detachments (n = 6). When cells were sequestered in the subretinal space, palucorcel was well tolerated and may be associated with improvements in visual acuity. Larger randomized controlled studies are required to confirm these results. Future studies would require a modified surgical approach.

      PubDate: 2017-04-25T09:19:08Z
      DOI: 10.1016/j.ajo.2017.04.006
  • Aqueous Humor Cytokines in Patients With Acute Nonarteritic Anterior
           Ischemic Optic Neuropathy
    • Authors: Hande Guclu
      Abstract: Publication date: Available online 21 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Hande Guclu

      PubDate: 2017-04-25T09:19:08Z
      DOI: 10.1016/j.ajo.2017.03.034
  • Stem cells for retinal disease: a perspective on the promise and perils
    • Authors: Rajesh C. Rao; Vaidehi S. Dedania; Mark W. Johnson
      Abstract: Publication date: Available online 17 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Rajesh C. Rao, Vaidehi S. Dedania, Mark W. Johnson
      Purpose To summarize key concepts, and early safety and efficacy signals from clinical trials for stem/progenitor cell-based interventions for retinal disease. Design Interpretive essay. Methods Review and synthesis of selected recent reports of stem/progenitor cell-based approaches for retinal disease, with interpretation and perspective. Results Stem/progenitor cell-based interventions represent a novel class of potential therapies for retinal diseases, such as age-related macular degeneration, inherited retinal dystrophies, and others. Sources include pluripotent stem cells, fetal and postnatal tissues. Two mechanisms of “rescue” have been proposed: regenerative or trophic. While pluripotent and fetal sourced-cell types have been tested in preclinical animal models of retinal disease, many postnatal stem/progenitor cell populations currently in trial do not have preclinical safety or efficacy data. Some early phase trials of cell therapies suggest acceptable safety profiles. Other reports, involving some types of autologous, non-ocular cell sources, have been linked to severe, blinding complications. Larger trials will be needed to determine short and long-term safety and efficacy of these cell-based interventions. Conclusions Stem/progenitor cell-based interventions have the potential to address blinding retinal diseases that affect hundreds of millions worldwide. Yet no FDA-approved stem cell therapies for retinal disease exist. While some early phase trial data are promising, reports of blinding complications from cell interventions remain troubling. It is paramount to apply a strong level of scientific rigor toward a well-planned, step-wise sequence of preclinical and clinical studies, to determine whether this class of potential therapies will be safe and effective for individuals with retinal diseases.

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.04.007
  • Socioeconomic disparity in global burden of cataract: an analysis for 2013
           with time trends since 1990
    • Authors: Lixia Lou; Jingyi Wang; Peifang Xu; Xin Ye; Juan Ye
      Abstract: Publication date: Available online 17 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Lixia Lou, Jingyi Wang, Peifang Xu, Xin Ye, Juan Ye
      Purpose To assess socioeconomic disparity in global burden of cataract, by using disability-adjusted life years (DALYs). Design International, comparative burden-of-disease study. Methods Published data on national age-standardized DALY rates caused by cataract and human development index (HDI) between 1990 and 2013 were obtained. The association between age-standardized DALY rates and HDI in 2013 was analyzed. The health-related Gini coefficients and the concentration indexes were calculated to explore the trends in between-country inequality in cataract burden from 1990 to 2013. Results Multiple comparison revealed that lower HDI countries had higher age-standardized DALY rates caused by cataract. Age-standardized DALY rates were inversely associated with HDI (β = -0.522, P < 0.01). From 1990 to 2013, global age-standardized DALY rates showed a trend of decline, whereas the Gini coefficients increased from 0.409 to 0.439. The concentration indexes indicated that socioeconomic associated inequality declined in the 1990s and subsequently increased since 2000, with values of -0.259 in 1990, -0.244 in 2000, and -0.273 in 2013. Conclusions Global health progress in cataract was accompanied by widening inequality, with cataract burden being more concentrated in countries with lower socioeconomic status. The findings highlight the need to provide more cataract services for developing countries, to combat global vision loss caused by cataract.

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.04.008
  • The Impact of the Medicare Access and CHIP Reauthorization Act (MACRA) On
           the Field of Ophthalmology
    • Authors: Brenton Kinker; Kaitlyn Dobesh; Nariman Nassiri; Mark S. Juzych; M. Roy Wilson
      Abstract: Publication date: Available online 14 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Brenton Kinker, Kaitlyn Dobesh, Nariman Nassiri, Mark S. Juzych, M. Roy Wilson
      Purpose To analyze the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on the field of ophthalmology. Design A perspective on the effects of MACRA’s Quality Payment Program after analysis of the proposed rule, final rule, and commentary submitted by relevant stakeholders. Results Physicians will need to use one of two payment structures: Merit Based Incentive Payment Systems (MIPS), or Alternative Payment Models (APMs). APMs and MIPS will focus on bundling payments and reimbursing based on "fee-for-service-plus" models, which take into account clinical outcomes, coordination of care, clinical improvement and electronic information exchange and security. APMs have substantial advantages, with eligible participants receiving a bonus and a higher rate of annual adjustment over the program’s life. For most ophthalmology practices, MIPS may be more appropriate due to its broader applicability and current paucity of APMs for ophthalmologists. Conclusion The Quality Payment Program is a substantial improvement over the negative adjustments under the repealed Substantial Growth Rate model. Ophthalmologists will likely utilize the MIPS system; however, its comparatively lower reimbursements, as well as its cost, quality, and other reporting measures may prove problematic.

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.04.002
  • Quality of Life Outcomes from a Randomized Clinical Trial Comparing
           Antimetabolites for Intermediate, Posterior, and Panuveitis
    • Authors: Katherine M. Niemeyer; John A. Gonzales; Sivakumar R. Rathinam; Manohar Babu; Radhika Thundikandy; Anuradha Kanakath; Travis C. Porco; Erica N. Browne; Maya M. Rao; Nisha R. Acharya
      Abstract: Publication date: Available online 14 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Katherine M. Niemeyer, John A. Gonzales, Sivakumar R. Rathinam, Manohar Babu, Radhika Thundikandy, Anuradha Kanakath, Travis C. Porco, Erica N. Browne, Maya M. Rao, Nisha R. Acharya
      Purpose To evaluate the changes in quality of life in noninfectious uveitis patients treated with two of the most commonly prescribed antimetabolite treatments. Design Secondary analysis of a multicenter, block-randomized, clinical trial ( NCT01232920). Methods Eighty patients at Aravind Eye Hospitals in Madurai and Coimbatore, India, with noninfectious intermediate, posterior, or panuveitis were randomized to receive oral methotrexate, 25 mg weekly, or oral mycophenolate mofetil, 1 g twice daily, and were followed up monthly for 6 months. Best-corrected visual acuity, IND-VFQ, and SF-36 were obtained at enrollment and at 6 months (or prior in the event of early treatment failure). Results IND-VFQ scores, on average, increased by 9.2 points from trial enrollment to 6 months (95% CI: 4.9, 13.5, P =0.0001). While the SF-36 physical component summary score did not significantly differ over the course of the trial, the mental component summary score decreased by 2.3 points (95% CI: -4.4, -0.1, P=0.04) and the vitality subscale decreased by 3.5 points (95% CI: -5.6, -1.4, P=0.001). Quality of life scores did not differ between treatment arms. Linear regression modeling showed a 3.2 point improvement in IND-VFQ score for every 5 letter improvement in visual acuity (95% CI: 1.9, 4.3; P<0.001). Conclusions Although uveitis treatment was associated with increased vision and vision-related quality of life, patient-reported physical health did not change after 6 months of treatment, and, mental health decreased. Despite improved visual outcomes, uveitis patients receiving systemic immunosuppressive therapy may experience a deterioration in mental health-related quality of life.

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.04.003
  • Corneal Endothelial Cell Density in Children: Normative Data From Birth to
           5 Years Old
    • Authors: Kenneth J. Hoffer
      Abstract: Publication date: Available online 14 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Kenneth J. Hoffer

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.02.032
  • Importance of Accommodation and Eye Dominance for Measuring Objective
    • Authors: Yukari Tsuneyoshi; Kazuno Negishi; Kazuo Tsubota
      Abstract: Publication date: Available online 12 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Yukari Tsuneyoshi, Kazuno Negishi, Kazuo Tsubota

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.03.025
  • Importance of Accommodation and Eye Dominance for Measuring Objective
    • Authors: Andrzej Grzybowski; Ronald A. Schachar; Barbara K. Pierscionek; Norman S. Levy; Ira H. Schachar
      Abstract: Publication date: Available online 12 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Andrzej Grzybowski, Ronald A. Schachar, Barbara K. Pierscionek, Norman S. Levy, Ira H. Schachar

      PubDate: 2017-04-18T08:54:10Z
      DOI: 10.1016/j.ajo.2017.03.024
  • Postoperative Efficacy, Predictability, Safety, and Visual Quality of
           Laser Corneal Refractive Surgery: A Network Meta-analysis
    • Authors: Daizong Wen; Colm McAlinden Ian Flitcroft Ruixue Qinmei Wang Jorge
      Abstract: Publication date: June 2017
      Source:American Journal of Ophthalmology, Volume 178
      Author(s): Daizong Wen, Colm McAlinden, Ian Flitcroft, Ruixue Tu, Qinmei Wang, Jorge Alió, John Marshall, Yingying Huang, Benhao Song, Liang Hu, Yune Zhao, Senmiao Zhu, Rongrong Gao, Fangjun Bao, Ayong Yu, Ye Yu, Hengli Lian, Jinhai Huang
      Purpose To compare the postoperative efficacy, predictability, safety, and visual quality of all major forms of laser corneal refractive surgeries for correcting myopia. Design Systematic review and network meta-analysis. Methods Search of MEDLINE, EMBASE, Cochrane Library, and the US trial registry was conducted up to November 2015. Randomized controlled trials (RCT) reporting in accordance with the eligibility criteria were included in this review. We performed a Bayesian random-effects network meta-analysis. Results Forty-eight RCTs were identified. For efficacy (uncorrected visual acuity [UCVA]), there were no statistically significant differences between any pair of treatments analyzed. The SUCRA (surface under the cumulative ranking curve) ranking (from best to worst) was femtosecond-based laser in situ keratomileusis (FS-LASIK), LASIK, small-incision lenticule extraction, femtosecond lenticule extraction (FLEx), photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), epipolis (Epi)-LASIK, transepithelial PRK (T-PRK). For predictability (refractive spherical equivalent [SE]), a statistically significant difference was found when FS-LASIK was compared with LASIK (odds ratio [OR] 2.29, 95% credible interval [CrI] 1.20–4.14), PRK (OR 2.16, 95% CrI 1.15–4.03), LASEK (OR 2.09, 95% CrI 1.08–4.55), and Epi-LASIK (OR 2.74, 95% CrI 1.11–6.20). The SUCRA ranking (from best to worst) was FS-LASIK, T-PRK, LASEK, PRK, LASIK, Epi-LASIK. There were no statistically significant differences in the safety (best spectacle-corrected visual acuity) comparisons. For both postoperative higher-order aberrations (HOAs) and contrast sensitivity (CS), there were no statistically significant differences between any pair of treatments analyzed. The SUCRA ranking results show that some corneal surface ablation techniques (PRK and LASEK) rank highest. Conclusions This network meta-analysis shows that there were no statistically significant differences in either visual outcomes (efficacy and safety) or visual quality (HOAs and CS). FS-LASIK behaved better in predictability than any other type of surgeries.

      PubDate: 2017-04-11T08:48:30Z
  • Increased Frequency of Topical Steroids Provides Benefit in Patients with
           Recalcitrant Postsurgical Macular Edema
    • Authors: Peter A. Campochiaro; Yong S. Han; Tahreem A. Mir; Saleema Kherani; Gulnar Hafiz; Claudia Krispel; T.Y. Alvin Liu; Jiangxia Wang; Adrienne W. Scott; Ingrid Zimmer-Galler
      Abstract: Publication date: Available online 7 April 2017
      Source:American Journal of Ophthalmology
      Author(s): Peter A. Campochiaro, Yong S. Han, Tahreem A. Mir, Saleema Kherani, Gulnar Hafiz, Claudia Krispel, T.Y. Alvin Liu, Jiangxia Wang, Adrienne W. Scott, Ingrid Zimmer-Galler
      Purpose To compare standard and frequent topical steroids for postsurgical macular edema (ME) Design Randomized clinical trial Methods Subjects with postsurgical ME stratified into post-cataract surgery ME (PCSME) and post-other surgery ME (POSME) were randomized to ketorolac four times a day (qid) + 1% prednisolone acetate (PA) every hour while awake (q1hWA, group 1) or qid (group 2). Mean change from baseline best corrected visual acuity (BCVA) was determined at week 12 after which group 2 subjects with persistent edema were crossed over to PA q1hWA. Results Twenty-two subjects (13 PCSME and 9 POSME) were randomized to group 1 and twenty (12 PCSME and 8 POSME) to group 2. At week 12, change from baseline BCVA (ETDRS letters) in group 1 vs 2 was +11.6 vs +8.5 (p=0.32) and for subgroups was +10.6 vs +7.8 (p=0.23) for PCSME and +13.1 vs +9.4 (p=0.47) for POSME. Mean change from baseline CST (μm) at week 12 in group 1 vs 2 was -100.8 vs -63.9. Mean change from baseline intraocular pressure was +2.6 vs +1.7 mmHg (p=0.52). Eight subjects in group 2 with residual ME at week 12 were switched to PA q1hWA and at week 24, the mean changes from week 12 BCVA and CST were +7.0 letters (p=0.01) and -108.25 μm (p=0.04). Conclusions Our data suggest that patients with postsurgical ME should initially be treated with ketorolac and PA qid, but if edema does not resolve after 12 weeks, a switch to ketorolac qid and PA q1hWA may provide benefit.

      PubDate: 2017-04-11T08:48:30Z
      DOI: 10.1016/j.ajo.2017.03.033
  • Randomized, controlled, crossover trial comparing the impact of sham or
           intranasal neurostimulation on conjunctival goblet cell degranulation
    • Authors: Koray Gumus; Karri L. Schuetzle; Stephen C. Pflugfelder
      Abstract: Publication date: Available online 14 March 2017
      Source:American Journal of Ophthalmology
      Author(s): Koray Gumus, Karri L. Schuetzle, Stephen C. Pflugfelder
      Purpose The aim of the study was to investigate the effects of the Oculeve Intranasal Lacrimal Neurostimulator (ILN) on conjunctival goblet cell degranulation. Design A randomized, double-masked, placebo-controlled crossover trial Methods A total of 15 subjects (5 normal and 10 dry eye) were enrolled in a three-visit study consisting of one screening and two separate randomized-masked ILN treatments (sham extranasal or intranasal). Tear meniscus height (TMH) was measured by AS-OCT before and after applications. Impression cytology (IC) was taken from the bulbar conjunctiva of the right eye for PAS staining and from the left eye for MUC5AC mucin immunostaining at baseline and after each treatment. The ratio of degranulated to non-degranulated GCs was measured as a marker of secretion. Results In all participants, both IB and TB cytology specimens stained for MUC5AC revealed a significantly higher ratio of degranulated to non-degranulated GCs after the ILN (IB: 2.28 ± 1.27 and TB: 1.81 ± 1.01) compared to baseline (IB: 0.56 ± 0.55, p= 0.015) (TB: 0.56 ± 0.32, p= 0.003) and extranasal sham application (IB: 0.37 ± 0.29, p= 0.001) (TB: 0.39 ± 0.33, p= 0.001). When the same analysis was repeated in the dry eye or control groups, the ratio was significantly higher after ILN than the baseline ratio and ratio after extranasal application in both groups (p< 0.05). Moreover, while control subjects had higher ratio of degranulated to non-degranulated GCs at baseline (0.75 ± 0.52) compared to the dry eye group (0.41 ± 0.27); the ratio became slightly higher in dry eye (2.04 ± 1.12 vs. 1.99 ± 1.21 in control) after the ILN application. There was no significant difference between the IB or TB conjunctiva locations in terms of the effectiveness of the ILN application on conjunctival goblet cell secretory response. Conclusions These preliminary results document that the Oculeve ILN can stimulate degranulation of goblet cells in the conjunctiva, which is a promising new approach for the management of dry eye. • This study protocol was registered on (#NCT02385292)

      PubDate: 2017-03-20T16:57:52Z
      DOI: 10.1016/j.ajo.2017.03.002
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
Home (Search)
Subjects A-Z
Publishers A-Z
Your IP address:
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-2016